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Oklahoma Health Care Authority Provides Cutting-edge Medicaid Service

Client:

Challenge:

Meet the Medicaid healthcare insurance needs of state citizens while preparing for change in the healthcare industry

Solution:

Leverage a scalable Medicaid Management Information System (MMIS) technology platform and flexible pool of outsourced technical resources to develop and manage an Online Medicaid Enrollment program

Results:

Flexible MMIS ensures state can respond to changes in healthcare industry more flexibly and cost-efficiently

Enrollment time greatly reduced in some instances from 20 days to 20 minutes allowing same day access to healthcare

Efficiency improvements through automation help the state accommodate healthcare programs with reduced administrative costs

Oklahoma Health Care Authority (OHCA) works with DXC Technology to provide online SoonerCare (Oklahoma Medicaid) claims processing to Oklahoma residents. In its role as fiscal agent, DXC implemented and maintains a Medicaid Management Information System (MMIS) for accepting and adjudicating Medicaid claims. In partnership with OHCA, DXC in 2014 served more than 42,000 providers processing over 63 million claims for over 1 million members.

The healthcare industry is experiencing immense change — and as a result, state governments that administer the federal/state Medicaid program may find themselves rushing to respond to shifting federal mandates and their members’ changing expectations. Due to a relationship with DXC (as Hewlett Packard Enterprise prior to the merger) that spans more than 15 years, the state of Oklahoma is well positioned to meet new requirements.

Oklahoma’s MMIS is a robust and flexible national showcase designed specifically to accommodate the unexpected. So when OHCA needed to enhance its DXC-managed programs to offer same-day eligibility and enrollment services, current Affordable Care Act support and a plethora of new features, it relied upon its durable and successful relationship with DXC.

“We made a strategic decision in 2000 to implement and outsource a new MMIS,” says Nico Gomez, OHCA CEO. “We determined it needed to be extremely flexible, because we knew there would be constant changes, changes we couldn’t even contemplate at the time. Through the state’s competitive bid process, we contracted with [DXC]. [DXC] brought the design and management expertise that was needed for the project. This success has resulted in a relationship that is still going strong today.”

Since the original implementation of its DXC-designed MMIS, OHCA has impressively kept ahead of a vast array of changing and evolving state and federal Medicaid requirements and regulations.

Lisa Gifford, chief of Business Enterprises at OHCA, cites an example of the system’s built-in flexibility. Within months of implementation, the system needed to grow from three SoonerCare health products to 10, each with different benefits and eligibility requirements. “We would never have been able to accomplish this so smoothly if it weren’t for the design decisions and flexibility that [DXC] made when it planned the system,” she emphasizes. “It was a fairly simple and inexpensive process that proved the design.”

Sharing success

When the Affordable Care Act came online in 2013, OHCA and DXC had been operational with its leading-edge online Medicaid eligibility system for a remarkable 3 years. OHCA personnel appear on national panels and conferences and regularly host other states, who come to study the success of the DXC-designed and -managed MMIS.

Derek Lieser, director of Enrollment Automation & Data Integrity, OHCA, further illustrates a few of the features that make the Oklahoma system stand out. “Our online SoonerCare system goes several steps beyond the average implementation,” he explains. [DXC] helped us

DXC works closely with OHCA to understand its specific needs and designs strategically for the most effective results. “The unique ability to determine eligibility and then progress to active health services on the same day is the kind of strategic and highly-integrated service we want to give the Oklahoma public. Our working relationship with [DXC] is the key,” echoes Gomez. “[DXC] meets with us, listens to us, brainstorms with us and then actualizes the design. It’s a very communication-centric relationship. [DXC] is very instrumental in our status as a showcase state.”

DXC not only created and implemented the online eligibility system, it manages the entire Oklahoma MMIS for OHCA. This consists of SoonerCare claims processing from beginning to end, clinical case management system support, customer call center, management and reporting, and others. It’s a complete one-stop-shop outsourcing solution.

Oklahoma SoonerCare goes mobile — sooner rather than later

Recently, DXC has further enhanced the self-service portal MySoonerCare, which has become a popular feature among SoonerCare participants. It’s available in English and Spanish and adaptable for additional languages as needed. The portal now allows the member to log on and change providers, through federally mandated browser-neutral access, at any time of the year.

And to make all the new features highly available to the state’s population, DXC implemented mobile access to the system, supporting the breadth of available mobile devices. DXC also implemented the ability to use email correspondence for quick support and instant user feedback. These electronic media initiatives are consistent with OHCA’s “going green” effort to reduce the costs of paper and postage.

“The single component that makes our implementation a showcase for innovation is the great care [DXC] has put into executing our major instruction — make it flexible, designed to modify and evolve,” says Gomez. “[DXC] developed with reusable code. For example, since we now support email, as we next move to support text messages, we can reuse much of the same code. The design is very efficient and therefore, economical.”

Furthermore, the DXC-managed MMIS centralizes many data feeds into a main hub, fulfilling another federal requirement. Multiple sources of federal information are automatically accessed and integrated into achieving the final goal: for a member to be seen by a physician the same day. Efficiency and productivity are maximized on all fronts.

“[DXC] now processes approximately 1,200 SoonerCare ID cards for OHCA daily, and all cards are processed within 24 hours of the request,” adds Lieser. “We’ve amazingly reduced enrollment time from 20 days to 20 minutes. And very key for our accountants and our members alike, automation supports efficiency improvements to help the state accommodate more healthcare programs with less budget.”

DXC treats OHCA business goals as its own

Lieser believes that working with DXC is like having an additional department of like-minded employees next door. They are a team. The DXC-managed data center runs 24x7, and both hardware and software support issues are also handled on
a teamwork basis as discussed and prioritized. DXC manages SoonerCare online enrollment, eligibility determination and claims processing, as well as call center platform and internet help-desk support for members and providers. And DXC recruits and trains the state’s providers on navigating the MMIS process and website.

“Currently over 1 million Oklahoma SoonerCare members count on our ability to react flexibly and quickly to ensure they have timely access to needed healthcare,” concludes Lieser. “Today up to 4,000 Oklahomans touch the website each day and complete 30,000 applications monthly. They need to easily understand and be able to navigate the process. [DXC] has done an outstanding job in setting up a very user- successful site. Believe me, the fact that we have few complaints means it’s working well and a lot of citizens are getting good and timely healthcare. That’s satisfying.”

*This success story was originally written by HPE Enterprise Services, which is now a part of DXC Technology as of April 2017.